Everyone experiences stress. Stress can occur in situations ranging from noisy children, problems on the job, or planning a wedding, right on up to a death in the family. People who take medications for mental illnesses like bipolar disorder may find that they can cope with small and even moderate stresses better than they could without meds. But what happens when these medications come up against severe stress?
My I'm Bipolar Journal shows that stress has been building steadily ever since my mother began showing symptoms of dementia. Even hiring a long-time friend as a caregiver didn't help as much as I'd hoped. When Nohemi was beside her, Mom would call out for ME every few minutes. And Nohemi's weekends off were pure hell. One weekend Mom fell in the middle of the night and I had to call the paramedics, because although she wasn't hurt, I couldn't get her up by myself.
I finally gave in to the obvious and agreed that it was time to move Mom into an assisted living facility with an Alzheimer's unit. Making that decision left me drained at first, but it was also a weight off my shoulders.
Medications and Stress
My psychiatrist asked me if I thought my medications were working. "How do I know?" I replied. "There's so much stress that I can't evaluate the effect of the meds."
We talked about how difficult it was for me to focus on important tasks -- things like paying bills and catching up with accounting work for my job. Dr. Meyer suggested a low dose of Ritalin to improve my concentration. At the same time, he said to discontinue the antidepressant Cymbalta, a precaution against the possibility of developing mania or hypomania.
When I started taking Ritalin, I found it helped immediately. I caught up completely with my accounting work. A friend and I completed the first stage of getting my paperwork under control. I got the bills paid and our checking accounts reconciled. I felt better. I wasn't even experiencing my usual panic about traveling as the date approached for what I had come to call My Weekend.
My Weekend
I had taken the occasion of a Saturday business conference to arrange two whole days away from Mom. Nohemi was going to stay with her. Even though the conference was held in a nearby city, I decided to stay at a hotel rather than commute. Friday night there was to be an informal get-together on a cruise boat. Meetings all day Saturday and dinner that night. On Sunday I was going on an afternoon cruise with people attending the conference. I can't tell you how much I was looking forward to this weekend!
Then on Friday morning, the day I was to leave, Mom collapsed when she got into Nohemi's car to go to the hairdresser. She was conscious and calling for help, but we couldn't get her out. So I called the paramedics again, and this time they took her to the hospital.
I called my brothers and told them what happened. I said I was still going away for the weekend because whatever was wrong with Mom did not seem to be life-threatening. I sent all the relevant papers to the hospital with Nohemi -- and then went into mental paralysis. I had to have a friend to talk me through packing (just for a weekend!) over the phone.
Eventually I went off for My Weekend, three hours later than I'd wanted to leave. My brothers stepped up and took over dealing with the hospital, the doctors and the nurses. Mom was so disruptive the first night that the hospital insisted we hire round-the-clock sitters for her, because the nurses couldn't cope. My brothers took care of this, too. (Thank you, guys!)
The weekend was not as relaxing as I had hoped, but I did enjoy it. I think sensitivity to noise is one of my personal markers of bipolar disorder, and the noise in the restaurant was so bad I kept having to go outside. The noise level inside the Sunday cruise ship was absolutely painful. Fortunately, once we'd eaten we could go up on deck where it was quiet. The weather was perfect. I stood in the wind at the rail and just absorbed the lake air and the sounds of the water.
Then I went home to an empty house. It was almost shocking.
Reaction Time
I thought I'd get rested and feel better being alone in the house, but it didn't happen. My exhaustion increased. I no longer noticed any energy or improved concentration from the Ritalin. My friend wisely said it was a reaction to having the minute-to-minute stress suddenly lifted. Sounds right.
I vegetated for three days, not even going to the hospital because I felt seeing me would agitate Mom. On Thursday, I actually went to the office -- to be greeted by the news that the business was moving this weekend, and I will be working entirely from home from now on.
So for two days I scrambled to do as much as I could, notifying essential services of the move, cleaning out my desk, etc. Friday night I was a zombie -- but I couldn't sleep. I woke up at 12:30 a.m., and at 1:30, 2:45, 3:20, 4:15, 4:30, and 4:45, when I got up.
So I filled the coffeepot and poured the water into the coffeemaker, then emptied the excess into ... the wastebasket. I banged my elbow hard on a cabinet, and it was ten seconds before I said, "Ow." Ten minutes later, I realized I hadn't ever turned the coffeemaker on.
And about six hours later, I discovered why I hadn't been able to sleep: I had forgotten to take my night-time meds the night before. (So at least I know THEY work!)
This morning, I woke up with a nice head cold. Ever notice how common it is to get sick after a stressful situation has eased up?
Stress vs. Meds - Who Wins?
When the stress is as severe as it has been in my life this year, the medications lose. Meds you've been taking all along may still be acting the same way, and maybe everything would be much worse without them, but you can't tell. A new medication that helped at first and then petered out may require an adjustment in dosage, or it may be that the situation is stronger than the drug. Bottom line: when severe stress goes on and on for too long, you are the loser.
